PRC Tech

PRC Tech

Department: Health Center

Summary:

To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required.

This individual is responsible for providing support and technical assistance in the management and administration of the Purchased Referred Care (PRC) program.

Essential Functions:

Determines patient eligibility for care under the PRC program

Determines the priority for services provided under the PRC program

Researches potential CHEF cases to collect documentation, prepares and submits CHEF cases to Area Office. Maintains files for the CHEF Case Management Program

Monitors that automated denials system to ensure all denials are entered

Manage denial package for non-referrals or no alternate resources

Administers the day-to-day activities required of the PRC program by initiating PRC purchase orders.

Retrieve and sort incoming PRC mail

Research claims received from providers to determine eligibility and alternate resources

Review patient’s visits and appointments to verify insurance information

Communication with providers related to patients with no alternate resources

Review bills from patients and creates purchase orders as necessary

Work closely with Benefits Coordinator and other staff to assure prompt processing of alternate resources

Reviews the bi-monthly referrals report from WebTPA. Works with the referrals coordinator to issue referrals needed

Answer phone calls related to the PRC program and/or claims status inquires

Utilize the WbTPA (iii:PUT) system to check on claims status. Communicate as necessary

Creates a tracking and following-up system on process related to the PRC program

Develops and implements FMIHC policies and procedures. Guidelines, and operating instructions, and maintains reference files on all Purchased Referred Care

Explain and interprets regulations and policies to health service providers and recipients, as well as FMIT personnel

Good Communication skills and the ability to deal with patients and families during potentially stressful times

Maintain strict patient confidentiality following state and federal laws

Performs other duties assigned by manager

Education:

High school graduate or GED equivalent

Experience:

Three (3) years previous experience handling referrals and/or processing claims preferred.

Experience working in a medical office.

Previous electronic medical record experience required.

Must be organized and able to manage multiple tasks in stressful situations

Good computer and phone skills

Good critical thinking skills that allows for quick assessment of patient needs

Certificates and Licenses:

Physical Demands:

Able to sit for extended periods of time

The Indian Preference Act will be enforced. The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities associated with it. The Fort Mojave Indian Tribe reserves the right to amend and change responsibilities to meet business and organizational needs.

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By | 2020-02-21T21:09:58+00:00 February 21st, 2020|Job Openings|0 Comments